ANTC61 Lecture 8.pdf

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21 Apr 2012
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Lecture 8- Efficacy of Traditional Medicines and Production of Medical Knowledge
Story: A student at the medical school a Chinese doctor taught at was not feeling well and asked for a check - up. A number of tests were
done and she was told she had an advanced form of cancer. You never compromise the patient's ability to get better --> doctor should
never limit the patient's natural healing (nocebo effect)
Biomedical practitioners are bound by laws. There are debates about this idea of placebo (bioethics).
Informed consent: you must give patients informed consent to prevent being penalized.
Biomedicine is integrated into the social and political system of a society. Biomedical assumptions can be encoded in law and shape
judicial proceedings, and the law also constrains biomedical practice.
You practice psychiatry and call it fatigue to allow costs to be covered.
A doctor may lie on behalf of a patient to allow a patient to have a procedure (medical insurance companies).
Therapeutic silence: you don't disclose some medical information because disclosing will lead to distress and this info doesn't have
a huge impact.
i.e. A drug must perform greater than a placebo to be deemed efficacious.
James Waldram: points out that placebos are systematically devalued in scientific research. They're not easily explicable in terms of
the organic model of disease and they are distrusted. The biosciences seek to excise the things that can't be control because we want
to design effective interventions that we can control.
Biomedicine is organized around what constitutes knowledge.
They help people see experience in a different way, experience different mental states and in the process mobilize healing
potential.
Anthropology of religion is focused on the effectiveness of ritual through performatives (illocutionary effect). Performative s is
a speech act. For example, you are married changes the world because from that moment on, they are married. If set up in
appropriate ways, ritual speech changes many things.
Saying you are healed in a certain context will create the belief and expectation that of healing, and sometimes doing that c an
change the body.
Shamans: one view states that they though deceive, shamans are effective workers of the placebo effect (which is not just a pill, but a
process).
Levi- Strauss: in the structure of a healing myth can change the . Mental and emotional trauma have meanings based on their
occurrences in a historical and cultural context. However the psyche works, it follows certain laws and processes to navigate. The
forms of stories can address structure of the psyche. If we can one day demonstrate a physical material basis for psyche, psychiatry
and shamanism will be seen to be the same. He is more speculative than Csordas.
It's not enough to look at the final outcomes of the healing practices, but also the process by which these occurs. The final
outcome isn't always what we want. Most of his cases of healing aren't as effective as Levi- Strauss' because Csordas' cases are
truly people.
Where do we locate the structures that L-S is talking about? What about failure or immodest success of placebo?
However, like M-S, he's focusing on a meaning- centered (interpretive model). Csordas focuses on the moments of efficacy.
Thomas Csordas: While this may be true, the placebo is imprecise. It doesn't account for the cases where people try to employ the
effect and it doesn't work. He's looking at North American spiritual healing and he wants to talk about threshold healing, where there
is only a modest change. He wants to know why this is happening. He employs a phenomenological (lived experience- what it feels
like to be embodied) approach and pays close attention to people's reports of their experiences during the process of healing (an open-
ended process).
Traditional medicines
This a troubled question. People give different meanings to illness. Should be use scientific measures to qualify success?
Giving a topical cream that heals may not help the patient feel satisfied. A shaman might argue that this is not success.
Empirical: based on experience, but not as stringent as scientific. Ayurvedic medicine has an empirical basis. Knowledge
is constantly tested and restructured based on experience.
Scientific: no biases, open to challenge
Ritual (symbolic): the idea of performatives and the meaningful effects of ritual. A person can say I am healed though I
have my disease.
Young: There are 3 different ways of measuring efficacy.
A First Nations ritual is done for one person, but several people are healed.
Who's the patient? Individual, community
A mental- emotional disorder may be something you live with forever, so it can only be ameliorated.
When is the right time to determine efficacy? Right after, 1 year; no relapse
As biomedicine spreads, healers start using biomedical terms and they may not mean the same thing. Waldram talks
about a healer who talks about cirrhosis but he means eczema.
How is the condition understood?
The healer wasn't effective, the patient wasn't compliant
What would constitute failure?
Who has authority to determine efficacy?
Possible disagreements according to Waldram:
Notions of success and failure depend on your criteria. Using a certain set of criteria that doesn’t try to treat a certain aspect of the
patient shouldn't be used to measure the efficacy of traditional medicine. Waldram argues that traditional medicine is measured
against a criteria that it doesn't try to heal. Each stakeholder holds a different view that is dynamic and so efficacy is constantly
shifting (fluid) --> depends on who you ask.
How do we discuss the efficacy of traditional medicine?
Efficacy of Traditional Medicines
Lecture 8
Wednesday, March 02, 2011
2:03 PM
ANTC61 Page 1
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